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NOTE
With proper validation \�1 ' �•
this form constitutes an `J
CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC . WORKS CONSTRUCTION (ENCROACHMENT)
(DA.)E 7R1 P OVERSIZE LOAD PERM)T�
For the construction of public or private curbs, driveways,. pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
a DATE: Minor Improvement Permit Class IV
-LOCATION OF CONSTRUCTION MOVE ERM F
- R
(Street address or.Description of Location) .
PURPOSE OF CONSTRUCTION 2 3 g Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION • HAUL RDUTE
MILES . f WASH INC -770 M
�/b ” TD q f3 "--i ;SIJ D .
DIMENSION OF INSTALLATION OR REMOVAL 1� ���� I IC? (ia0L�S WASffi1 R1G70Q
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN AUC DA 7S 0 1171(p-cl0
APPROXIMATE TIME OF COMPLETION '
ESTIMATED CONSTRUCTION COST $
t (Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing 'permanent resurfacing and/or replacing improvements) `
In consideration of the -granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate. result of any work undertaken under the permit granted *pursuant to this application.
Notify the Administrative Authority at least •twenty-four (24) hours in advance of the time when work will be started.
• N --Comply with all 'applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of.Applicant•(
1\1LAEVO EN67)AJEF-R)AK-1 ((D1.9.) 3LIS - 17 78
Name of Applicant (please print) Business Address Telephone No.
FI CDti1 7V_j(_K) G,
Name of Contractor and Job Foreman Business Address Telephone No.
DA.I FILE DAV FI LE
Contractor's License No. City Business License No.
DAI -FILE DIV FILE
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit —Class III
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction, costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee ,
.y
Permit Fee
Penalty
.Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
$
Received by Date
Q05JB" W W6 ii -i6-90 ' 10
0 6ASH i TOTAL -1 i0:00
N2 03J.7
PERMIT VALIDATION
PERMIT NO. Q 9) -7
DATE APPROVED I" ib " 90
EXPIRATION DATE )^ 1 LP r C) 0
DATE ISSUED } ) -' LP_ 19 0
By U.s'�-
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
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A
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NOTE: i 4
'With proper validation
� p
this formrcoristitutes an _° o
(encroachment permit T' CITY- OF LA QUINTA
m .
a
APPLICATION FOR PERMIT
F
c
-PUBLIC'•WORKS CONSTRUCTION. (ENCROACHMENT)
OME KIF OVFRS#Z �aA1� RE M►
For the, construction_• of -public or .private curbs, driveways, pavements, sidewalks, parking .lots„sewers, water mains
+ ,and other like public works improvements in connection with MINOR IMPROVEMENTS and,APPROVED'SUBDIVISIONS
Subdivision Improvement Permit - Class I II
DATE: � ` Minor Improvement Permit Class IV -F_ 02 -
e . LOCATION OF CONSTRUCTION`j!f);
''t(Street address or Description of Location) - F
PURPOSE OF CONSTRUCTION Sketch (attach construction plans if appropriate) `
< H AIA L )=' o r V
`DESCRIPTfON OF CONSTRUCTION
DIMENSION OF -INSTAL CATIONOR REMOVAL` (` 'I ) � t 't IC%• 0� WA
' 'SIZE OF EXCAVATION, IFN EEDED c• _
APPROXIMATE TIME.WHEN'WORK WILL BEGIN."r
;
APPROXIMATE TIME OF COMPLETION °
ESTIMATED CONSTRUCTION COST $
(Including.removal of all obstruction, materials, and'debris, backfilling,com
pactionr and placing per,manent� resurfacing and/or replacing improvements) }A
In consideratiori; of th'e•.granting of this permit; the applicant hereby agrees to:_
Indemnify,. defend and save the,City, its authorized'agents, officers, representatives and employees, harmless from and against any and,all.:
penalties, ;liabilities or -I ss* resulting from ;claims or court action and arising out of any accident, 'loss or damage to persons or property.
happening .or occurring as a proximate result of. any wo'k.undertaken under the permit granted pursuant to this application: '
v•^ V 1 `
Notify the Administrative Authority at least twenty-four (24) hours.in advance of the time when work will be started:, `
',:Comply with all applicable City. Ordinances,.the.'terms'and conditions of the permit and all applicable rules and regulations of the City: of
La Quints and to pay for any additional replacement necessary as.the result of this work.
{ Signature of Applicant o�r, Agent.
f -e
Name of Applicant (please print) Business Address' Telephone No. ,
Name of.Contractor and Job -Foreman , ,. ,Business Address. Telephone No.
`Contractor's License No. City Busiriess'Licerise No.
NJ FlIVE
Applicant's Insurance Company Policy Number
.FEES:. Subdivision Improvement Permit"—'Class III . ,•
..Public improvements: 3%of'estimated construction costs.�}AS}{+ 1 tjTA(„ 10.4.0 i..
' • ” Private: improvements: 3% of estimated construction'costs
' Minor. Improvement Permit — Class IV: See attached schedule
6
Inspection' Fee. $' _ 4. PERMIT, VALIDATION
Permit Fee !Q..fI 0 �') '7
. PET NO.
Penalty DATE APPROVED -11- )to- 9.17
Cash Deposit-Su'rety•Bol d
if required
f EXPIRATION DATE
` TOTAL: L$' /r .:� P3 t' f I' )LP" Q U
Receipt No: r
Received'by. '' Date s
Recorded by
z
DATE ISSUED,
t U . Administrative'Authority
TELEPHONE: (619) 564-2246 ,
VOTE: -
Nith proper validation
his form constitutes an
encroachment permit
CITY OF LA QUINTA
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class III
DATE: "I - Minor Improvement Permit Clan: IV
LOCATION OF CONSTRUCTION
(Street address or Oescription of Location) n
PURPOSE OF CONSTRUCTION �' 1Lrn /
L`� � 11,L 01�'A Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION /�UZt•
DIMENSION OF INSTALLATION OR REMOVAL' ILI 1 1 l /r7 ` IAL
SIZE OF EXCAVATION,IF NEEDED �ZAIrlm
APPROXIMATE TIME WHEN WORK WILL BEGIN
(/
APPROXIMATE TIME OF COMPLETION
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the -permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) ho urs in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Ap Icant gr Agent
Nuevo Engineering, Inc. 79-811 Country Club, Bermuda Dunes 619-3145-1778
Name of Applicant (please print) Business Address Telephone. No.
of Contractor and Job Foreman
actor's License No.
icant's Insurance Company
EES: Subdivision Improvement Permit —Class III
Business Address Telephone No.
City Business License No.
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
ction Fee $
it Fee
Ish Deposit -Surety Bond
required
TOTAL: $
No.
eceived by Date
ecorded by
Policy Number
N°
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED
EXPIRATION DATE
DATE ISSUED
By
Administrative Authority
TELEPHONE: (619) 564.2246